Late Management of traumatic thoracic spine fractures

Hi, I fractured my back close to 2yrs ago (compression t4 and t5 vertebral bodies) from a fall.  Originally it was missed on xray and i had mobilisation physio treatment until it was identified a couple of months later.  My question is whether at this stage there is any surgical treatment options that may be of benefit.  I am in my mid 20's, I have completed a thorough rehab/stability program (and continue with these ex's) but i have ongoing significant stiffness and pain which has interfered with my ability to continue to work in the area of physical therapy.  Is vertebroplasty still an option or is it too late for that are there any other options for managment?  Any help would be appreciated.  
Thanks

[Nassim Abi Chahine, MD]

Thank you for your question: be sure that a Th4 and Th5 fractures do not necesitate any surgery in your case because the physiotherapy of this region is symply not effective in most of centers all aro looking to the presence of the rib cage who works as a brace or a fixator of this region. Go to your work freely and forget about this small problem where I am not sure of a fracture in this region, at the same unexperienced medic may see normally shaped vertebrae as fractures (they simply have a specific telescoping look here). Moreover in your age you have a strong ability of ossification so your bones become stronger after fracures and no chance to distract them with any procedure. The ossification time in this region relatively to your age is 2 to 3 weeks only :)

Dr Nassim

[mollie102]

Hi Nassim, thankyou for your response.  I originally fell around 2m and landed on my thoracolumbar junction on a step.  The fractures where identified on MRI, bone scan and retrospectively on the x-ray (it was not a good quality xray).  (I have no history of Scheuermann's disease/evidence of other endplate pathology at any other level) I understand the fracture is well an truly healed by now.  I have had extensive physiotherapy and followed a comprehensive home exercise program however i continue to have significant stiffness (less than 30degrees rotation)  and limited extension.  this has made work in musculoskeletal physiotherapy very difficult and aggravated my back to the extent i have recently changed to hospital based physiotherapy for my work (this is not the area i enjoy working in) this has enable the pain to settle significantly but i continue to be very stiff and have a numb patch of about 5cm wide around my chest.
Given the extensive physio i have completed change in work duties i am interested if there is any other options for management? and if the increased kyphosis caused by the original fractures may be contributing to the problem.
Thanks again
Mollie  

[kys11]

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